Sethi Dhruv, Mohiddin Obadeh, Kelleher Cecilly, Kasetty Venkatkrish M, Kumar Nitin, Desai Uday R, Hamad Abdualrahman
Ophthalmology, Retina Group of Washington, Fairfax, USA.
Ophthalmology, Case Western Reserve University, Cleveland, USA.
Cureus. 2025 Aug 4;17(8):e89329. doi: 10.7759/cureus.89329. eCollection 2025 Aug.
This report discusses a case of diagnosing neurosyphilis in a non-classical presentation with confounding test results needing a deliberate and multidisciplinary diagnostic approach. A 38-year-old immunocompetent male presented with uveitis and a skin rash. Although serology was positive for syphilis (rapid plasma reagin 1:128), it was also positive for tuberculosis, and a dermatology consult identified the rash as psoriasis, creating a complex diagnostic picture. Based on a high suspicion of ocular syphilis, the patient received intravenous penicillin, which led to the complete resolution of his ocular symptoms and a serologically confirmed cure. This case of an ophthalmic masquerading disease was complicated by misleading clinical signs and a coexisting positive serology, serving as a reminder to maintain a broad differential diagnosis and be systematic in workup and management in order to optimize clinical outcomes.
本报告讨论了一例以非典型表现诊断神经梅毒的病例，其检测结果令人困惑，需要采取审慎的多学科诊断方法。一名38岁免疫功能正常的男性出现葡萄膜炎和皮疹。虽然梅毒血清学检测呈阳性（快速血浆反应素1:128），但结核血清学检测也呈阳性，皮肤科会诊将皮疹诊断为银屑病，从而形成了复杂的诊断情况。基于对眼梅毒的高度怀疑，患者接受了静脉注射青霉素治疗，其眼部症状完全缓解，血清学检查证实已治愈。这例伪装成眼科疾病的病例因误导性的临床体征和同时存在的血清学阳性结果而变得复杂，提醒我们要保持广泛的鉴别诊断，并在检查和管理中做到系统有序，以优化临床结果。
